Monthly Archives: October 2012

“FOR decades, scientific research has shown that annual physical exams — and many of the screening tests that routinely accompany them — are in many ways pointless or (worse) dangerous, because they can lead to unneeded procedures.”

Thus spake Elizabeth Rosenthal of the New York Times earlier this year. With all the talk of prevention being cheaper than treatment, we need to take a serious look at what constitutes rational preventive care.

Personally, I have no idea what to do about PSA tests. The U.S. Preventive Services Task Force, a nongovernmental panel of independent experts in prevention and evidence-based medicine, says that we shouldn’t run these tests routinely. My doctor thinks otherwise. How many peer-reviewed papers do I have to read to make the right decision?

Answer: There is no right answer. The doctor makes his conclusions based on clinical experience and scientific evidence. The Task Force looks at large populations of men. Can I live with the odds? What if I’m am outlier? Should the insurance company (meaning all of us, now) have to pay for a test?

The Big Questions: Will prevention result in improved wellbeing, and Is our push for prevention going to lead to higher costs or lower?

Something to wonder as you sit in the exam, freezing in nothing but that hospital gown, waiting for the EKG patches to get glued to your chest, or the annual Pap smear, or the ol’ prostatic palpation.

(from the New Yorker Rejection Collection)

Current guidelines recommend that women should have a Pap test every 3 years beginning at age 21. These guidelines further recommend that women ages 30 to 65 should have HPV and Pap cotesting every 5 years or a Pap test alone every 3 years. Women with certain risk factors may need to have more frequent screening or to continue screening beyond age 65.

My kids’ pediatrician doesn’t “believe” in the flu shot. That’s the word he uses, but since I know him to a person who thinks carefully about things, I know he means that for him the evidence just doesn’t add up. I look at the same evidence and I come to a different result. I am getting the flu shot, and my children will also. I don’t have a choice–the United States Army Reserve requires that I get vaccinated. They figure that a soldier with the flu isn’t worth much, and is a danger to other soldiers. Right on both counts.

As for my kids’ doctor, he’ll give patients the injection if their parents ask for it, or if they are in a one of the groups designated as high risk. The concern with healthcare workers, of course, is that they will be super-spreaders of the disease to vulnerable populations. People infected with influenza begin to shed virus before they begin to show signs.

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An Online Journal of Chagas’ Disease, Rabies, Beverages from South America, Dishes from the Sixties, and Other Public Health Issues

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Richard Lerner

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